Bruise vs. Hematoma: How to Tell the Difference

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Closeup of woman with hematoma or bad bruise on knee
hematoma on knee
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While they may look similar, a bruise is not the same as a hematoma. They can have some of the same causes, though injuries that result in a hematoma are often much more serious. Find out the difference between a bruise and a hematoma, and be aware of telltale signs that a hematoma needs emergency medical care.

Bruise vs. Hematoma: Definitions

A bruise definition is an injury in which small blood vessels break and bleed under the skin, leaving discoloration in the injured area. A bruise is also known as a contusion.

A hematoma can be defined as a pool of blood trapped outside a blood vessel. If you have a hematoma, your skin might feel spongy, rubbery or lumpy. Hematomas can occur in many places on the body, even deep within the body. Some hematomas are medical emergencies. An acute subdural, or intracranial hematoma is also known as subdural hemorrhage, which is bleeding on the brain. This condition needs emergency treatment, which may include surgery to drain the blood.

Causes and Risk Factors

While a bruise is not a hematoma, they can be caused by similar things.

Bruise causes and risk factors: Bruises are usually caused by accidental injuries, such as bumps and falls. Other conditions can also cause bruises, such as bleeding disorders. People who are at an increased risk of bruises include those with a deficiency of vitamin C, bleeding disorders, or who take blood thinners. Older people, who have thinner skin, may have more noticeable bruises after minor bumps or accidents.

Hematoma causes and risk factors: A hematoma is usually caused by some sort of trauma. This can include accidents that cause bruises, and more serious injuries, such as gunshot wounds, car accidents, broken bones, head injuries, and deep vein thrombosis (blood clot in the leg). Older people and those who take blood thinners are at an increased risk of developing a hematoma. Not using sporting helmets and seat belts is a risk factor for a subdural hematoma and other types of intracranial hematomas that occur between the skull and brain.

Bruise vs. Hematoma Symptoms

The symptoms of a bruise vs. a hematoma are where the biggest differences lie. Hematoma symptoms can range from as minor as bruise symptoms, but can also be much more serious, even life threatening.

Bruise symptoms: Discolored skin, usually dark blue, purple or black; shows up on the skin at the site of the injury. The area is usually tender to the touch. Bruise color changes from bluish-purple to green to brownish-yellow before completely fading away.

Hematoma symptoms: The symptoms of a hematoma are usually more severe than those of a bruise. Symptoms might appear immediately after the injury, or they may take several weeks to show up. In addition to pain, tenderness and skin discoloration, you may experience serious symptoms.

Subdural hematoma symptoms may include headache, vomiting, dizziness, confusion, unequal pupil size, slurred speech, paralysis, loss of consciousness, or seizures. These symptoms indicate a life-threatening situation.

Other hematomas may present different symptoms, including incontinence or abdominal pain.

Treatment

Depending on their severity, you can sometimes treat bruises and hematomas at home. Over-the-counter painkillers can help relieve pain symptoms, but don’t take aspirin, which is a blood thinner and can make the bruising worse. For both bruises and hematomas, it’s best to rest and avoid strenuous activity until any swelling subsides.

Bruise treatment: Bruises are often minor and won’t require medical treatment. You can treat a bruise with a cold compress for 10 to 20 minutes every hour by wrapping ice or a bag of frozen peas in a towel. Don’t put ice directly on your skin. If desired, you can gently wrap the bruise with an elastic bandage; be sure it isn’t too tight. Elevate the bruised area as much as possible.

Hematoma treatment: Mild hematomas can be treated at home with the same care options as for bruises. If you notice severe symptoms or if the hematoma enlarges over the next few days, see a doctor. You may need medical imaging tests, such as an X-ray, CT scan or ultrasound, to check for more serious injuries. If you have severe symptoms, get immediate medical help.

When to See a Doctor

Anyone who develops symptoms of a serious hematoma after an injury should seek medical attention immediately. Because hematomas can develop internally and damage organs, seek medical attention after any type of trauma, including falls and sports injuries.

If you notice pus, a fever, increased swelling or pain, or an increase in size of the bruise or hematoma, call your doctor—these are signs of infection that should be treated right away.

If you develop a bruise after an injury, you can ask a healthcare provider to evaluate it and possibly take an X-ray to make sure you haven’t broken any bones. Your provider can most likely evaluate it during a virtual, telehealth-type medical appointment. If there is a concern, follow up with an in-person appointment. And because frequent bruising can indicate a bleeding disorder, talk with your doctor if you experience regular bruising.

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Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2020 Dec 4
THIS TOOL DOES NOT PROVIDE MEDICAL ADVICE. It is intended for informational purposes only. It is not a substitute for professional medical advice, diagnosis or treatment. Never ignore professional medical advice in seeking treatment because of something you have read on the site. If you think you may have a medical emergency, immediately call your doctor or dial 911.
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